The payer landscape is shifting and the demands of patients are changing too. Consumerism, in fact, is creating vulnerabilities for health systems.

A system based on the demands of consumers and one geared toward the usual payers, government and commercial, are two completely different environments. Yesterday's, and in many cases, today's revenue cycle focuses more on collecting from government and commercial payers, which is very technical and centered on coding, filing, various rules. Staffing in most rev cycles tends to go in that direction, too, according to Bob Mueller, St. Luke's Health vice president of revenue cycle.

"We are hitting a tipping point. So it is a significant risk point for us and other health systems," Mueller said.

Patients, on the other hand, are looking for much more of a retail experience with similar expectations for the financial experience and understanding bill and process options. Historically, revenue cycle operations are understaffed to operate in that kind of patient-centric environment as well.

THE PROBLEM

As of 2013, St. Luke's decided to poll patients on their billing experience satisfaction at a time when they were in the infancy of using a digital solution. Mueller said they hadn't looked at patient statements in a long time and found they were far too technical for patients. They ended up finding only 28 percent of patients were satisfied with the system's billing process. They weren't surprised but they certainly weren't happy about it either.

"It's really that understanding of what patients are looking for that is missed," Mueller said.

THE PROPOSAL

With more and more patients asking "why can't I self-serve?" and "can you tailor an experience more relevant to me? Why can't I get a consolidated view of my bills?" St. Luke's system set out to overhaul its patient financial experience on three levels: the actual interactions with patients via their call centers; the layout and content of their paper statements; and really diving in and taking full advantage of the digital patient portal platform they had adopted, VisitPay.

MARKETPLACE

In addition to VistPay, there are numerous patient portal tools out there, both standalones and those that are part of a larger EHR system. Stand-alone patient portal tools with varying capabilities include Solutionreach, updox, Mend, Connect Patient by Chart Logic and Bridge Patient Portal.

MEETING THE CHALLENGE

First, the focus in call centers was to enhance the current staff's abilities and training, and then also boost staffing levels, such that when calls came in they were answered in a timely fashion by better trained staff and in most cases, were able to resolve the issue at the time of the phone call. They also started recording calls for training purposes and immediately solicited feedback on the quality of interactions to use in continued staff training and education.

Next, St. Luke's changed its paper statement to be more user-friendly with a clearer presentation of information. "A happy, satisfied, informed patient will pay more and is willing to make payments," Mueller said.

Information in the statement was clearly segmented into sections addressing what was paid the previous month, new charges, old unpaid balances and what's covered by a patient's payment plan for those who have one.

Finally, St. Luke's made full use of its digital strategy through the VisitPay patient portal platform, and they are now up to 60,000 users. Patients now have the ability to view and pay bills online and to explore options for payment, including setting up payment plans if they chose that method.

Mueller used a personal anecdote to describe the difference between dealing with a system that offered such a platform and one that didn't. A family member had spinal fusion surgery, a significant procedure that was followed by big bills. This surgery involved care through multiple systems. The bills that were from St. Luke's were easy to deal with using VisitPay, as he was able to look at options and pay in the privacy of own home without human intervention. Mueller said he felt empowered. With other facilities had to call the office and negotiate the payment, and said he got the sense that they were reluctant to extend the payment plans.

"I left each of those encounters without that feeling that I had a partnership with these providers and it was a less than satisfactory experience," he said.

Mueller explained that patients want to pay their debt and to have options that work for them. They don't want to be second-guessed as to whether they are trying to get out of something and sometimes calling and asking for extended payment option is intimidating. The bottom line? Giving patients more control makes them happy and then they tend to pay.

He added that VisitPay offers support to address patient account management beyond the portal, with business intelligence capabilities a system can use to analyze where their cash is coming from, how well outside vendors are working for St. Luke's i.e. collection agencies who are also collecting on St. Luke's behalf.

"It's not just a patient portal but tools that help a system manage patient accounts across the board," he said.

It also automatically segments patients by tracking such metrics as their propensity to pay, pay without any contact from the system, whether they pay via paper statement, patients who won't pay and patients who need to be called.

RESULTS

This year St. Luke's saw a big jump, hitting 52 percent patient satisfaction with the billing experience, and Mueller said those on a paper platform are not as satisfied as those using a digital platform. Satisfaction with the digital billing experience is "upwards of 80 percent at times."

He said the digital platform is clear and understood, and patients have more options in controlling payment arrangements and can do it digitally. The experience looks similar to other more retail-like bills.

St. Luke's has realized a 30 percent rise in yield on a risk-adjusted basis, comparing groups of consumers using VisitPay with consumers not using VisitPay, collecting balances that are owed instead of writing off as bad debt.

As for the patient statement changes, Mueller said they are capturing "upwards of two million dollars more" paid each month than before they overhauled the statements.

Finally, St. Luke's has enjoyed a 38 percent improvement in self-pay collections and a 21 percent reduction in cost-per-dollar collected across the revenue cycle.
"Every dollar collected is one less dollar that goes to bad debt for the bottom line. All that improvement would have been additional cost and expense had it not been collected," he said.

ADVICE FOR OTHERS

Muller said in the future patients will continue to be more and more accountable for healthcare costs. The trend isn't going away and will only become more impactful. Education communication and sharing program offerings with patients in terms of what's available to them will not only be crucial to satisfaction, it will become the norm, much like it is in retail. So setting yourself up with the ability to cater to patient demands not only means loyalty to your system -- but it also means a healthier bottom line.

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